Fundación Favaloro. Fundación Favaloro

Size: px
Start display at page:

Download "Fundación Favaloro. Fundación Favaloro"

Transcription

1 Superficial Femoral Artery: Which h Factors Influence Patency? Oscar A. Mendiz.MD.FACC.FSCAI Chairman hi of Interventional Cardiology dil March 2010 Name: Oscar A. Mendiz Disclosure I have the following potential conflict of interest: Cordis: Advisory Board, Grant Research, Speaker. BSCI: Grant Research Elli Lilly; Speaker. Medtronic, Speacker. Braile Biomedica: Family representation Meetings Sponsorships: BSCI, Cordis, Acher (Cook), Medikar (ClearStream), Angiocor (AGA), BioSud (Abbott), Sanofi.

2 Restenosis Rate after PTA/Stenting of Peripheral larteries Internal carotid artery 2.5-5% Iliac arteries 5-15% Renal arteries 10-20% Fem-Pop 35-75% Below-the-knee 25-75% SFA Restenosis: Predictors Clinical features: Diabetes Tabaquism End stage Renal Failure Inflammation ( CRP) 1 Angiographic: g TASC C (stenosis >15cm) Procedural related: TASC D (CTSO >20 cm) Diffuse disease Severe calcification (suboptimal results) Poor run-off 2 Suboptimal results ( residual stenosis) Balloon vs. Stent 3 Stainless Steal vs. Nitinol Stent 3 Stent length Stent fracture 1 Shillinger M, et al. Radiology 2002 Oct:225(1): Davies MG, et al. J Vasc Surg May kawamura I, et al. J Vasc Surg Nov;50(5):

3 Balloon Angioplasty versus Implantation of Nitinol Stents in the Superficial Femoral Artery Restenosis Angiografía a 6 meses Duplex scan Schillinger M, et al. NEJM 2006;354: Freedom from 2 Years 100 m from TV VR(%) Cumulativ ve Freedo Log Rank p= % 46.2% Stent PTA Stent PTA (0) (1) 41 (5) 38 (8) 33 (13) 32 (14) 31 (15) 31 (15) 44 (8) 38 (14) 37 (15) 27 (25) 25 (27) 24 (28) 29 (17) 24 (28) Follow-up Time (months) Schillinger M, et al. Circulation 2007;115:2745

4 Bare Stent vs. POBA: 12-months restenosis at Randomized d trials Self-Expanding nitinol stents in the FP segment: technique and mid-term results Restenos sis Free Surviv val Months Mewissen, MW. Tech Vasc Int Radiol 2004;7:2-5

5 Bare Stent TLR at 12 and 24 months Study Stent Inclusion Criteria Durability (Bosiers 2009) n=134 FAST (Krankenberg 2007) n=127 Resilient: (Katzen ISET 2008) n=153 Protégé EverFlex Luminexx Stent 15% at 12 months No in-stent Lesion Length <14cm Rutherford 2-4 De novo lesions Length 1-10cm, multiple Ls, <10cm total >70%DS No in-stent Lesion Length <15cm Rutherford 1-4 TLR 21% 15% 13% at 12months 20% at 24 months Mechanical Forces in the SFA

6 Stent Fracture and Restenosis X-Ray Sistematic screening. Scheinert D, et al. JACC 2005;45:312-5

7 Stent Fracture and Restenosis X-Ray Sistematic screening. 12 months 48% P< % 80% 27% 60% 40% 20% St With Fracture St Without Fracture 0% Scheinert D, et al. JACC 2005;45:312-5 Stents Vs. Balloon Stent Fracture: ADi Disappointmenti after first enthusiasm Scheinert D, et al. J Am Coll Cardiol, 2005, Jan 18

8 Stents Fracture-Rates of Different Nitinol Stents Stent / Trial Fracture-rate 12-Months Patency Luminexx 52.1% <50% (FESTO-trial) SMART 16.1% 82.1% (FESTO) SMART (Sirocco) 11-31% >80% Absolute (Vienna) 2.0% 63.3% LifeStent (Resilient) 2.0% 80% Everflex (Durability) 8.1% 72.2% Scheinert D, Linc 2010 Which Lesions are we Treating? Maris, multicenter Registry % Lesion Type Lesion Lengh T Zeller, LINC 2010

9 Which Lesions are we Treating? Maris, multicenter Registry Restenosis or reocclusion on duplex US at 373±days by lesion type % T Zeller, LINC 2010 Which Lesions are we Treating? Maris, multicenter Registry Restenosis or reocclusion on duplex US at 373±days by lesion length % T Zeller, LINC 2010

10 Which Lesions are we Treating? Maris, multicenter Registry Univariate analysis on restenosis or reocclusion on duplex US: Diabetes + Gender % T Zeller, LINC 2010 Drawbacks of Current Generation Stents Nor or insufficient axial flexibility (stent design) Suboptimal surface finishing contributing to earlier fatigue. Insufficient stent-length resulting in multiple overlaps. p Patients Drawbacks: Usually treat long and severely calcified lesions.

11 Stent Design improved but not yet optimal EPIC-Stent NovoStent s Alternating ti Helix SAMBA FlexStent SFA; Meta-Analysis: Outcomes of interventions for recurrent disease after endoluminal dl li intervention ti for superficial i lf femoral artery disease. 5 years PTA 66 Surgery Primary Patency Symptoms Relief Morbidity Davies MG, et al. J Vasc Surg May 15.

12 SFA: New strategies to prevent restenosis Atherectomy (debulking pre stent) Cryoplastia Drug Eluting Stent Drug Eluting Balloon Biodegradable-DES First In Man Experience Fava M, et al. JVIR 2004;15:

13 Cryoplasty: y SFA Baseline Acute 6 Months 18 Months Dr Mario Fava Dr Mendiz. ISET FemPac Trial 6-months Restenosis Survival without TLR & amputation

14 THUNDER TRIAL Local Taxan with short time contact for reduction of restenosis in distal arteries Binary Restenosis at 12 months % Patien ntes Tepe G, et al, Thunder Trial. N Eng J Med 2008;358: THUNDER TRIAL Local Taxan with short time contact for reduction of restenosis in distal arteries Late Lumen Loss at 6 Months % Patien ntes Tepe G, et al, Thunder Trial. N Eng J Med 2008;358:

15 Drug Eluting Balloons: Is Additive Necessary? Drug Eluting Stents: SIROCCO SFA Stenting Study SIROCCO I n=36 SIROCCO II n=57 Sirolimus Control Sirolimus Control Estenosis >70% de 7-20 cm Estenosis >70% de cm Oclusiones de 4-20 cm Oclusiones de cm Smart stent de 8 cm Smart stent de 8 cm Máximo 3 Máximo 2

16 SIROCCO I SIROCCO SFA Stenting Study SIROCCO II Reestenosis angiográfica a 6 meses Sirolimus Control Sirolimus Control % 0 7.7% Reestenosis Duplex scan 9 meses 9.7% 14.3% Reestenosis Duplex scan 18 meses 33.3% 29% Reestenosis Duplex scan 24 meses Drug Eluting Stents: Zilver PTX Scheinert D, europcr 2010

17 Zilver PTX Single arm registry Patency (PSVR <2.5) Stent fracture: 22/14432 St 1.5% Scheinert D, europcr 2010 Drug Eluting Stents: Zilver PTX Literature Comparisons Comparison of Silver PTX Single-Arm Study subsets Matched with published data show: Improved 12-months patency rates with Zilver PTX Close to 50% restenosis rate reduction with Zilver PTX Modified from Scheinert D, EuroPCR 2010

18 Bioabsorbable, DES (?): Conclusions: Using current technology we can treat more complex lesions. Stent restenosis rate at SFA is still high. Bare stent are superior than POBA. Current stent technology is not ideal. Cryoplatia and Drug Eluting Balloon seems promising but not definitive. New stent design are warranted.

19 Nevertheless.: Restenosis is better than amputation

20 SFA; Challenging environmental for Stent: Durability??:

Recurrent Stenosis in the SFA: Treatment Strategies

Recurrent Stenosis in the SFA: Treatment Strategies Recurrent Stenosis in the SFA: Treatment Strategies Darren B. Schneider, MD, FACS Disclosures W.L. Gore- research funding; speaker Cook, Inc.- research funding EV3 consultant Bard consultant Associate

More information

Popliteal artery: to stent or not to stent?

Popliteal artery: to stent or not to stent? Popliteal artery: to stent or not to stent? Karl-Ludwig Schulte Vascular Center Berlin Ev. Hospital Königin Elisabeth St. Gertrauden Hospital University Hospital Charité, CC11 Humboldt-University Berlin

More information

Majestic Trial 12 Month Results

Majestic Trial 12 Month Results Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.

More information

First Experience With Drug-Eluting Balloons in Infrapopliteal Arteries

First Experience With Drug-Eluting Balloons in Infrapopliteal Arteries Journal of the American College of Cardiology Vol. 58, No. 11, 2011 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.05.034

More information

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor

More information

Health Policy Advisory Committee on Technology Technology Brief

Health Policy Advisory Committee on Technology Technology Brief Health Policy Advisory Committee on Technology Technology Brief LifeStent vascular stent for symptomatic lesions of the superficial femoral or proximal popliteal artery August 2012 State of Queensland

More information

Intracoronary Stenting and. Robert A. Byrne, Julinda Mehilli, Salvatore Cassese, Franz-Josef Neumann, Susanne Pinieck, Tomohisa Tada,

Intracoronary Stenting and. Robert A. Byrne, Julinda Mehilli, Salvatore Cassese, Franz-Josef Neumann, Susanne Pinieck, Tomohisa Tada, Prospective, Randomized Trial of Paclitaxel-Eluting Balloon versus Paclitaxel-Eluting Stent versus Balloon Angioplasty for Treatment of Coronary Restenosis in Limus- Eluting Stents Intracoronary Stenting

More information

Percutaneous Angioplasty and Stenting of Infrainguinal Lesions: One Year Outcomes for Claudication versus Critical Limb Ischemia

Percutaneous Angioplasty and Stenting of Infrainguinal Lesions: One Year Outcomes for Claudication versus Critical Limb Ischemia [Index FAC] [FVCC Index] Enfermedades Vasculares Cerebrales y Periféricas/ Cerebral and Peripheral Vascular Diseases Percutaneous Angioplasty and Stenting of Infrainguinal Lesions: One Year Outcomes for

More information

Mechanical Properties of Nitinol Stents and Stent-grafts. Comparison of 6 mm Diameter Devices

Mechanical Properties of Nitinol Stents and Stent-grafts. Comparison of 6 mm Diameter Devices Mechanical Properties of Nitinol Stents and Stent-grafts Comparison of 6 mm Diameter Devices P E R F O R M A N C E b y d e s i g n Purpose The association of target vessel restenosis with stent fractures

More information

MEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE

MEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE Effective Date: October 1, 2015 Review Dates: 10/11, 10/12, 10/13, 8/14, 8/15 Date Of Origin: October 12, 2011 Status: Current Summary of Changes Clarifications:

More information

Comparison of Second-Generation Stents for Application in the Superficial Femoral Artery: An In Vitro Evaluation Focusing on Stent Design

Comparison of Second-Generation Stents for Application in the Superficial Femoral Artery: An In Vitro Evaluation Focusing on Stent Design Comparison of Second-Generation Stents for Application in the Superficial Femoral Artery: An In Vitro Evaluation Focusing on Stent Design Müller-Hülsbeck S, Schäfer PJ, Charalambous N, Yagi H, Heller M,

More information

Rethink Atherectomy: Expert Insights Into Clinical Application and Use of the JETSTREAM System

Rethink Atherectomy: Expert Insights Into Clinical Application and Use of the JETSTREAM System , LLC an HMP Communications Holdings Company September 2013 Volume 25/ Supplement B www.invasivecardiology.com The Official Journal of the International Andreas Gruentzig Society Rethink Atherectomy: Expert

More information

Drug-Eluting Balloons. Klaus Bonaventura Department of Cardiology and Angiology Heart Thorax Vascular Center, Klinikum Ernst von Bergmann, Potsdam

Drug-Eluting Balloons. Klaus Bonaventura Department of Cardiology and Angiology Heart Thorax Vascular Center, Klinikum Ernst von Bergmann, Potsdam Drug-Eluting Balloons Klaus Bonaventura Department of Cardiology and Angiology Heart Thorax Vascular Center, Klinikum Ernst von Bergmann, Potsdam Potential conflicts of interest Speaker s name: Klaus Bonaventura

More information

Claudication and Critical Limb Ischemia

Claudication and Critical Limb Ischemia Claudication and Critical Limb Ischemia Endovascular Treatment of Peripheral Arterial Disease Jason Wollmuth, MD, FACC Heart Center Cardiology Peripheral Arterial Disease Affects ~20% of adults older than

More information

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease. Erich Minar Medical University Vienna

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease. Erich Minar Medical University Vienna ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease Erich Minar Medical University Vienna for the Task Force on the Diagnosis and Treatment of Peripheral

More information

Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study

Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study Cardiovasc Intervent Radiol (2013) 36:353 361 DOI 10.1007/s00270-012-0492-z CLINICAL INVESTIGATION ARTERIAL INTERVENTIONS Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial

More information

The Pantera Lux Paclitaxel DEB Device Description and Clinical Studies. Christoph Hehrlein, University Clinic Freiburg i.br.

The Pantera Lux Paclitaxel DEB Device Description and Clinical Studies. Christoph Hehrlein, University Clinic Freiburg i.br. The Pantera Lux Paclitaxel DEB Device Description and Clinical Studies Christoph Hehrlein, University Clinic Freiburg i.br. Germany Disclosure Statement of Financial Interest Within the past 12 months,

More information

STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY

STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY Per Medical Board decision March 18, 2008: These credentialing standards do NOT apply to peripheral angiography performed in the context

More information

Supera Peripheral Stent System Instructions for Use

Supera Peripheral Stent System Instructions for Use Supera Peripheral Stent System Instructions for Use Table of Contents 1.0 DEVICE DESCRIPTION 2.0 HOW SUPPLIED 3.0 INDICATIONS 4.0 CONTRAINDICATIONS 5.0 WARNINGS 6.0 PRECAUTIONS 6.1 Stent Delivery System

More information

IN.PACT SFA: A Prospective Randomized Trial of a Drug- Coated Balloon for Femoropopliteal Lesions Two-Year Outcomes

IN.PACT SFA: A Prospective Randomized Trial of a Drug- Coated Balloon for Femoropopliteal Lesions Two-Year Outcomes IN.PACT SFA: A Prospective Randomized Trial of a Drug- Coated Balloon for Femoropopliteal Lesions Two-Year Outcomes John Laird, MD UC Davis, Sacramento, California USA On behalf of the IN.PACT SFA Trial

More information

Carotid Artery Stenting? Comparison of the outcome of octogenarian patients according to the stent type. Data from a multicentre registry

Carotid Artery Stenting? Comparison of the outcome of octogenarian patients according to the stent type. Data from a multicentre registry Closed- or Open-cell stents in Carotid Artery Stenting? Comparison of the outcome of octogenarian patients according to the stent type. Data from a multicentre registry Nikas D 1, Reimers B 2, Iakovou

More information

A Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III

A Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III A Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III Gilles Montalescot, MD, PhD Pitié-Salpêtrière Hospital, Paris, France

More information

percutaneous coronary intervention PCI PCI 1 PCI coronary rotational atherectomy 1 CT coronary computed tomographic angiography CCTA Agatston 100

percutaneous coronary intervention PCI PCI 1 PCI coronary rotational atherectomy 1 CT coronary computed tomographic angiography CCTA Agatston 100 20142222 Chin J Intervent Cardiol, 2014, Vol 22, No.2 69 R541.4 percutaneous coronary interventionpci coronary rotational atherectomy 40 49 50% 60 69 80 DOI10. 3969/j. issn. 1004-8812. 2014. 02. 001 [1-2]

More information

COMPLEX IN-STENT RESTENOSIS COMPLETE COVERAGE FOR. Data, comparative analysis, and consensus on the role of the GORE VIABAHN Endoprosthesis.

COMPLEX IN-STENT RESTENOSIS COMPLETE COVERAGE FOR. Data, comparative analysis, and consensus on the role of the GORE VIABAHN Endoprosthesis. Supplement to Sponsored by Gore & Associates June 2015 COMPLETE COVERAGE FOR COMPLEX IN-STENT RESTENOSIS Data, comparative analysis, and consensus on the role of the GORE VIABAHN Endoprosthesis. Complete

More information

Pantera Lux Device Description and Overview of Clinical Data

Pantera Lux Device Description and Overview of Clinical Data Pantera Lux Device Description and Overview of Clinical Data Ralph Tölg, MD Herzzentrum Segeberger Kliniken GmbH Bad Segeberg, Germany Disclosure Statement of Financial Interest Within the past 12 months,

More information

LEADERS: 5-Year Follow-up

LEADERS: 5-Year Follow-up LEADERS: -Year Follow-up from a Prospective, Randomized Trial of Biolimus A9-eluting Stents with a Biodegradable Polymer vs. Sirolimus-eluting Stents with a Durable Polymer : Final Report of the LEADERS

More information

Ostial LAD: Single stent approach is the best. Antonio A. Pocoví, MD, FSCAI, MTSAC, Advisory Council Member, CACI

Ostial LAD: Single stent approach is the best. Antonio A. Pocoví, MD, FSCAI, MTSAC, Advisory Council Member, CACI Ostial LAD: Single stent approach is the best Antonio A. Pocoví, MD, FSCAI, MTSAC, Advisory Council Member, CACI Chair, Interventional Cardiology Sanatorio San Lucas Instituto Alexander Fleming Buenos

More information

Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up

Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up Hellenic J Cardiol 45: 379-383, 2004 Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up PETROS S. DARDAS, DIMITRIS

More information

Renal artery stenting: are there any indications left?

Renal artery stenting: are there any indications left? there any indications left? Luís Mendes Pedro, MD. PhD, FEBVS Lisbon Academic Medical Centre (University of Lisbon and Hospital Santa Maria) Instituto Cardiovascular de Lisboa Disclosures Speaker name:

More information

Copenhagen University Hospital Rigshospitalet Aarhus University Hospital Skejby Denmark

Copenhagen University Hospital Rigshospitalet Aarhus University Hospital Skejby Denmark Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-elevation myocardial infarction 3 year follow-up of the randomised trial Peter Clemmensen, Henning Kelbæk,

More information

Endovascular treatment of symptomatic atherosclerotic

Endovascular treatment of symptomatic atherosclerotic Drug-Coated Balloon Versus Standard Percutaneous Transluminal Angioplasty for the Treatment of Superficial Femoral and Popliteal Peripheral Artery Disease 12-Month Results From the IN.PACT SFA Randomized

More information

Cilostazol versus Clopidogrel after Coronary Stenting

Cilostazol versus Clopidogrel after Coronary Stenting Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background

More information

Atherectomy in the Treatment of Lower-Extremity Peripheral Artery Disease: A Critical Review

Atherectomy in the Treatment of Lower-Extremity Peripheral Artery Disease: A Critical Review at 1 and 2 years compared with simple balloon angioplasty. 5-7 However, this therapy has limited applicability in lesions beyond 10 cm or in those with heavily calcified territories and in lesions of considerable

More information

My Approach to Complex BTK Disease New York 2014

My Approach to Complex BTK Disease New York 2014 My Approach to Complex BTK Disease New York 2014 Raj Dave, MD, FACC, FSCAI Chairman, Division Of Cardiology Director, Catheterization Laboratories Chief Medical Executive, Holy Spirit Cardiovascular Institute

More information

Do método diagnóstico ao terapêutico: a História da Hemodinâmica e da Cardiologia Intervencionista, em 15 minutos. Eulógio E Martinez

Do método diagnóstico ao terapêutico: a História da Hemodinâmica e da Cardiologia Intervencionista, em 15 minutos. Eulógio E Martinez Do método diagnóstico ao terapêutico: a História da Hemodinâmica e da Cardiologia Intervencionista, em 15 minutos Eulógio E Martinez IVUS vs luminologia Positivo Negativo estenose TCE oclusão CD sístole

More information

PERIPHERAL VASCULAR DISEASE: SURGERY VS. ENDOVASCULAR, RALPH A. CHAER, M.D. 1

PERIPHERAL VASCULAR DISEASE: SURGERY VS. ENDOVASCULAR, RALPH A. CHAER, M.D. 1 RALPH A. CHAER, M.D. 1 So it s sort of a nice segue to the last talk because we re going to talk about different interventions that would treat pain of the lower extremities, so different forms of pain

More information

Evolu'on of Balloon Angioplasty From POBA to newer technologies NCVH May 26, 2015

Evolu'on of Balloon Angioplasty From POBA to newer technologies NCVH May 26, 2015 Evolu'on of Balloon Angioplasty From POBA to newer technologies NCVH May 26, 2015 Cezar Staniloae, MD Heart and Vascular Ins7tute New York University Medical Center Overview 1. Physics of balloon angioplasty

More information

The Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program

The Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program The Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program Jean Fajadet, MD, FESC Clinique Pasteur - Toulouse - France Disclosure statement Nothing to disclose Dedicated Delivery

More information

Rotational Atherectomy for the Treatment of In-Stent Restenosis

Rotational Atherectomy for the Treatment of In-Stent Restenosis Home SVCC Area: English - Español - Português Rotational Atherectomy for the Treatment of In-Stent Restenosis Steven L. Goldberg, MD Cardiac Catheterization Laboratory, University of Washington Medical

More information

PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators

PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf

More information

Cath Lab Basics. Balloons and Stents. Tushar Raina MBBS MD MRCP Consultant Cardiologist Cheltenham General Hospital

Cath Lab Basics. Balloons and Stents. Tushar Raina MBBS MD MRCP Consultant Cardiologist Cheltenham General Hospital Cath Lab Basics Balloons and Stents Tushar Raina MBBS MD MRCP Consultant Cardiologist Cheltenham General Hospital I have no conflicts of interest to declare Evolution of Percutaneous Coronary Intervention

More information

Kim, Weon, MD, PhD Cardiovascular Center, GwangJu Veterans Hospital

Kim, Weon, MD, PhD Cardiovascular Center, GwangJu Veterans Hospital Complex Case for Critical Limb Ischemia Kim, Weon, MD, PhD Cardiovascular Center, GwangJu Veterans Hospital Case 1 79/M C/C Lt.3 rd toe necrosis & ant.tibial ulcer (O:1 weak ago) Claudication (O:1 year

More information

Earlier Access To Innovation Is It Worth It?

Earlier Access To Innovation Is It Worth It? Earlier Access To Innovation Is It Worth It? HTA Agency Perspective: Germany Dr. Alric Rüther, IQWiG Many thanks to Beate Wieseler and Stefan Sauerland for provision of slides Drivers for earlier access

More information

Antonio Colombo MD on behalf of the SECURITY Investigators

Antonio Colombo MD on behalf of the SECURITY Investigators Second Generation Drug-Eluting Stents Implantation Followed by Six Versus Twelve-Month - Dual Antiplatelet Therapy - The SECURITY Randomized Clinical Trial Antonio Colombo MD on behalf of the SECURITY

More information

Duration of Dual Antiplatelet Therapy After Coronary Stenting

Duration of Dual Antiplatelet Therapy After Coronary Stenting Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are

More information

Summary. Signature: Pol J Radiol, 2013; 78(3): 74-79 DOI: 10.12659/PJR.889245

Summary. Signature: Pol J Radiol, 2013; 78(3): 74-79 DOI: 10.12659/PJR.889245 Signature: Pol J Radiol, 2013; 78(3): 74-79 DOI: 10.12659/PJR.889245 CASE REPORT Received: 2013.04.02 Accepted: 2013.07.16 Mechanical thrombectomy using Rotarex system and stent-in-stent placement for

More information

The Bioresorbable Vascular Stent Dr Albert Ko

The Bioresorbable Vascular Stent Dr Albert Ko The Bioresorbable Vascular Stent Dr Albert Ko Dr Albert Ko MB BS, FRACP, FCSANZ Interventional/General Cardiologist Ascot Cardiology Symposium 2013 Treatment Goals for Coronary Artery Disease Relieve of

More information

Coronary Bifurcation Treatment: Update from the European Bifurcation Club. Remo Albiero, MD Ist. Clinico S. Rocco Brescia (Italy)

Coronary Bifurcation Treatment: Update from the European Bifurcation Club. Remo Albiero, MD Ist. Clinico S. Rocco Brescia (Italy) Coronary Bifurcation Treatment: Update from the European Bifurcation Club Remo Albiero, MD Ist. Clinico S. Rocco Brescia (Italy) Disclosure Statement of Financial Interest Within the past 12 months, I

More information

Thrombolysis, thromboaspiration, ultrasound thrombectomy: adjuncts techniques for aorto-iliac recanalization.

Thrombolysis, thromboaspiration, ultrasound thrombectomy: adjuncts techniques for aorto-iliac recanalization. Thrombolysis, thromboaspiration, ultrasound thrombectomy: adjuncts techniques for aorto-iliac recanalization. Dr. S. Schepers Dr. F. Van Elst Sint-Trudo Hospital Sint-Truiden Belgium Chronic aorto-iliac

More information

Myth Busters: Does Coronary Artery Bypass Grafting Impact Progression of Native Coronary Artery Disease?

Myth Busters: Does Coronary Artery Bypass Grafting Impact Progression of Native Coronary Artery Disease? Myth Busters: Does Coronary Artery Bypass Grafting Impact Progression of Native Coronary Artery Disease? Bobby Yanagawa MD PhD FRCSC Division of Cardiac Surgery St Michael s Hospital Shifting Our Attention

More information

Imaging of Thoracic Endovascular Stent-Grafts

Imaging of Thoracic Endovascular Stent-Grafts Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial

More information

Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions

Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions David Sacks, MD, Gary J. Becker, MD, and Terence A.S. Matalon, MD J Vasc Interv Radiol 2003;

More information

Presenter: Marco Valgimigli, MD PhD, FESC Erasmus MC, Thoraxcenter Rotterdam The Netherlands

Presenter: Marco Valgimigli, MD PhD, FESC Erasmus MC, Thoraxcenter Rotterdam The Netherlands Comparing zotarolimus-eluting and bare-metal stent efficacy in selected high bleeding risk patients treated with a short dual antiplatelet therapy duration. A pre-specified analysis from the The Zotarolimuseluting

More information

SAMPLE. Asia-Pacific Interventional Cardiology Procedures Outlook to 2020. Reference Code: GDMECR0061PDB. Publication Date: May 2014

SAMPLE. Asia-Pacific Interventional Cardiology Procedures Outlook to 2020. Reference Code: GDMECR0061PDB. Publication Date: May 2014 Asia-Pacific Interventional Cardiology Procedures Outlook to 2020 Reference Code: GDMECR0061PDB Publication Date: May 2014 Page 1 1 Table of Contents 1 Table of Contents... 2 1.1 List of Tables... 4 1.2

More information

CAAS QCA. The applications and benefits of quantitative coronary angiography

CAAS QCA. The applications and benefits of quantitative coronary angiography CAAS QCA The applications and benefits of quantitative coronary angiography Coronary angiography is routinely used for diagnosis and treatment of millions of patients who have or are at risk of coronary

More information

Statins: Can there be too much of a good thing?

Statins: Can there be too much of a good thing? Statins: Can there be too much of a good thing? Spoiler alert No Oh Contraire Haaaaiiiiiiile No! Frequently under prescribing statin therapy! Typical Case 68 YO Smoker ACS Multiple prior PCI s Multiple

More information

Drug Eluting Balloon in peripheral artery disease

Drug Eluting Balloon in peripheral artery disease Drug Eluting Balloon in peripheral artery disease Alessandro Furgieri MD Cardiovascular Department ICC Istituto Clinico Cardiologico Casal Palocco (RM) - Italy CLI Overview and Challenges Critical Limb

More information

Repeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation

Repeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation Original Contribution Repeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation Cynthia A. Yock, MS, J. Michael Isbill, MS, Spencer B. King III, MD, Mark

More information

The Heart and Beyond: Diseases of the Circulatory System

The Heart and Beyond: Diseases of the Circulatory System The Heart and Beyond: Diseases of the Circulatory System Mobeen A. Sheikh, M.D. Atherosclerosis affects all arterial beds Cerebrovascular disease Ischemic stroke Transient Ischaemic Attack (TIA) disease

More information

Causes of Leg Swelling. How good is CT for DVT? Direct CT Venography. Lower Extremity Venous Thrombosis and Leg Swelling: The Role of CT Venography

Causes of Leg Swelling. How good is CT for DVT? Direct CT Venography. Lower Extremity Venous Thrombosis and Leg Swelling: The Role of CT Venography Lower Extremity Venous Thrombosis and Leg Swelling: The Role of CT Venography Bart Dolmatch, MD Professor of Radiology UTSW Medical Center Dallas, TX Causes of Leg Swelling Venous thrombosis Venous stenosis

More information

Iliac Artery Disease: A Case-Based Approach To Stent Selection

Iliac Artery Disease: A Case-Based Approach To Stent Selection Society for Vascular Medicine Iliac Artery Disease: A Case-Based Approach To Stent Selection Annotated Cited Reference Material (2002). "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin

More information

Percutaneous transluminal angioplasty (PTA) is the

Percutaneous transluminal angioplasty (PTA) is the elow-the-knee therectomy Update look at devices in use or under investigation for treating CLI patients with complex lesions. y Robert M. ersin, MD, FSCI, FCC Percutaneous transluminal angioplasty (PT)

More information

Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?

Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital

More information

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

More information

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Appropriate Use: Big Brother is Watching Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Disclosures Consultant Boston Scientific, Medtronic, Middle Peak Medical, Millipede,

More information

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,

More information

Cutting Balloon Angioplasty for Resistant Renal Artery In-Stent Restenosis

Cutting Balloon Angioplasty for Resistant Renal Artery In-Stent Restenosis Cutting Balloon Angioplasty for Resistant Renal Artery In-Stent Restenosis Graham J. Munneke, MRCP, Christoph Engelke, MD, Robert A. Morgan, FRCR, and Anna-Maria Belli, FRCR A 76-year-old woman presented

More information

ORIGINAL ARTICLES: Morphology and Location of Restenosis Following Bare Metal Coronary Stenting

ORIGINAL ARTICLES: Morphology and Location of Restenosis Following Bare Metal Coronary Stenting Page 1 / 7 ORIGINAL ARTICLES: Morphology and Location of Restenosis Following Bare Metal Coronary Stenting - Marc J. Schweiger, MD, Ehsan Ansari, MD, Gregory R. Giugliano, MD, *James Mathew, MD, Ashequl

More information

Use of Stents and Stent Grafts to Salvage Angioplasty Failures in Patients with Hemodialysis Grafts

Use of Stents and Stent Grafts to Salvage Angioplasty Failures in Patients with Hemodialysis Grafts Use of Stents and Stent Grafts to Salvage Angioplasty Failures in Patients with Hemodialysis Grafts Thomas M. Vesely, Mohammed Zaheer Amin, and Thomas Pilgram St. Louis, Missouri ABSTRACT To determine

More information

Status of Drug-Eluting Coronary Stents

Status of Drug-Eluting Coronary Stents Status of Drug-Eluting Coronary Stents EVOLUTION OF PERCUTANEOUS CORONARY INTERVENTIONAL TECHNOLOGIES The introduction of percutaneous transluminal coronary angioplasty (PTCA) in the late1970s provided

More information

Vascular Stent System (6F, 20 100mm stents)

Vascular Stent System (6F, 20 100mm stents) 100000000922.2 Instructions for Use Cordis S.M.A.R.T. CONTROL Vascular Stent System (6F, 20 100mm stents) Cordis S.M.A.R.T. Vascular Stent System (6F, 120 150mm stents) Symbols Catalog Number LOT NonPyrogenic

More information

Is There A LIfe for DES after discontinuation of Clopidogrel

Is There A LIfe for DES after discontinuation of Clopidogrel Chicago 2014 Is There A LIfe for DES after discontinuation of Clopidogrel Six-month versus 24-month dual antiplatelet therapy after implantation of drug eluting stents in patients non-resistant to aspirin:

More information

FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium

FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Background 8 th Coronary Physiology in the CathLab Course Revascularisation of intermediate stenosis can be targeted EITHER

More information

Coronary Stents. What is a Coronary Artery stent?

Coronary Stents. What is a Coronary Artery stent? What is a Coronary Artery stent? Coronary Stents A coronary stent is stainless tube with slots. It is mounted on a balloon catheter in a "crimped" or collapsed state. When the balloon of is inflated, the

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Carotid Artery Angioplasty/Stenting (CAS) File Name: Origination: Last CAP Review: Next CAP Review: Last Review: carotid_artery_angioplasty_stenting_cas 4/2004 6/2015 6/2016 6/2015

More information

POST STENTING DUAL ANTIPLATELET THERAPY DURATION J BAUCUM MD FACC CAROLINA CARDIOLOGY GHS

POST STENTING DUAL ANTIPLATELET THERAPY DURATION J BAUCUM MD FACC CAROLINA CARDIOLOGY GHS POST STENTING DUAL ANTIPLATELET THERAPY DURATION J BAUCUM MD FACC CAROLINA CARDIOLOGY GHS Post Stenting Dual Antiplatelet Therapy When can I stop it? Intracoronary stenting is a frequent intervention for

More information

Celiac Artery & Superior Mesenteric Artery Disease, Diagnosis, and Treatment

Celiac Artery & Superior Mesenteric Artery Disease, Diagnosis, and Treatment Celiac Artery & Superior Mesenteric Artery Disease, Diagnosis, and Treatment Jason Roberts DHSc, RVT Technical Director of Non-Invasive Vascular Services First Coast Cardiovascular Institute DISCLOSURES

More information

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

Clinical characteristics & impact of Peripheral Vascular Disease in Diabetes. Keimyung University Hye Soon Kim

Clinical characteristics & impact of Peripheral Vascular Disease in Diabetes. Keimyung University Hye Soon Kim Clinical characteristics & impact of Peripheral Vascular Disease in Diabetes Keimyung University Hye Soon Kim Peripheral Vascular Disease Diseases to arteries & veins outside thoracic region Main cause

More information

Medical Devices. Driving Growth With Transformational Technology

Medical Devices. Driving Growth With Transformational Technology Medical Devices Driving Growth With Transformational Technology Forward-Looking Statement Some statements in this presentation may be forward-looking statements for purposes of the Private Securities Litigation

More information

Endovascular Repair of the Superficial Femoral Artery

Endovascular Repair of the Superficial Femoral Artery Supplement to Produced under an educational grant from W. L. Gore & Associates September 2008 Endovascular Repair of the Superficial Femoral Artery A roundtable discussion of the challenges in treating

More information

Editorial. Adult Cardiology - Meta-analysis

Editorial. Adult Cardiology - Meta-analysis Editorial Adult Cardiology - Meta-analysis Simple Versus Complex Bifurcation Stenting Strategies A Meta Analysis of Randomized Controlled Trials in the Drug Eluting Stent Era Ana Beatriz R. Medrano, MD

More information

Update on Interventional Cardiology Bioabsorbable Stents

Update on Interventional Cardiology Bioabsorbable Stents Update on Interventional Cardiology Bioabsorbable Stents Robert C. Welsh, MD, FRCPC Professor of Medicine Director, Adult Cardiac Catheterization and Interventional Cardiology Co-Chair, Vital Heart Response

More information

Not Cardio - Vascular Coding. Caren J Swartz, CPC-I, CPC-H, CPMA

Not Cardio - Vascular Coding. Caren J Swartz, CPC-I, CPC-H, CPMA Not Cardio - Vascular Coding Caren J Swartz, CPC-I, CPC-H, CPMA caren@practiceintegrity.com Objectives Understand Anatomy for Vascular Coding Review the Rules for Vascular Procedures Review ICD-10 future

More information

OHTAC Recommendation

OHTAC Recommendation OHTAC Recommendation Multiple Sclerosis and Chronic Cerebrospinal Venous Insufficiency Presented to the Ontario Health Technology Advisory Committee in May 2010 May 2010 Issue Background A review on the

More information

Using Clinical Registries to Create Evidence-based Health Care Policy : Experiences from Ontario, Canada

Using Clinical Registries to Create Evidence-based Health Care Policy : Experiences from Ontario, Canada Using Clinical Registries to Create Evidence-based Health Care Policy : Experiences from Ontario, Canada April 2009 Jack V. Tu, MD PhD FRCPC CANADA RESEARCH CHAIR IN HEALTH SERVICES RESEARCH Institute

More information

INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment

INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment Christoph A. Nienaber, MD, FACC University Heart Center Rostock Department of Medicine I - Cardiology christoph.nienaber@med.uni-rostock.de

More information

University of Ulsan College of Medicine, Asan Medical Center on behalf of the REAL-LATE and the ZEST-LATE trial

University of Ulsan College of Medicine, Asan Medical Center on behalf of the REAL-LATE and the ZEST-LATE trial Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park MD PhD Seung-Jung Park, MD, PhD, University of Ulsan

More information

European Heart Journal (1999) 20, 1014 1019 Article No. euhj.1998.1395, available online at http://www.idealibrary.com on

European Heart Journal (1999) 20, 1014 1019 Article No. euhj.1998.1395, available online at http://www.idealibrary.com on European Heart Journal (1999) 20, 1014 1019 Article No. euhj.1998.1395, available online at http://www.idealibrary.com on Working Group Report Indications for intracoronary stent placement: the European

More information

Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute

Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute Dual Antiplatelet Therapy Stephen Monroe, MD FACC Chattanooga Heart Institute Scope of Talk Identify the antiplatelet drugs and their mechanisms of action Review dual antiplatelet therapy in: The medical

More information

Vascular ultrasound in aortic endoleaks

Vascular ultrasound in aortic endoleaks Vascular ultrasound in aortic endoleaks Nicos Labropoulos Professor of Surgery and Radiology Director, Vascular Laboratory Division of Vascular Surgery Stony Brook University Medical Center Stony Brook,

More information

Table 5: Chronic Mesenteric Artery Disease Elements and Definitions

Table 5: Chronic Mesenteric Artery Disease Elements and Definitions History Risk Factors Atherosclerosis Known atherosclerosis in any vascular territory Patient Assessment - Symptoms Indicate if any of the symptoms listed below are present Symptoms suggestive of mesenteric

More information

Peripheral Arterial Disease: Why You Should Care & How You Can Help. Jon Zlabek, MD, FACP Vascular Medicine

Peripheral Arterial Disease: Why You Should Care & How You Can Help. Jon Zlabek, MD, FACP Vascular Medicine Peripheral Arterial Disease: Why You Should Care & How You Can Help Jon Zlabek, MD, FACP Vascular Medicine jazlabek@gundluth.org Today s Objectives Review the assessment, diagnosis and treatment of peripheral

More information

EXCITE ISR: Initial Results. Eric J. Dippel, MD FACC On behalf of the EXCITE ISR Investigators

EXCITE ISR: Initial Results. Eric J. Dippel, MD FACC On behalf of the EXCITE ISR Investigators EXCITE ISR: Initial Results Eric J. Dippel, MD FACC On behalf of the EXCITE ISR Investigators Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial

More information

IN.PACT ADMIRAL DRUG-COATED BALLOON NEW TECHNOLOGY ADD-ON PAYMENT (NTAP)

IN.PACT ADMIRAL DRUG-COATED BALLOON NEW TECHNOLOGY ADD-ON PAYMENT (NTAP) IN.PACT ADMIRAL DRUG-COATED BALLOON NEW TECHNOLOGY ADD-ON PAYMENT (NTAP) New Technology Add-on (NTAP) for DCB OVERVIEW Effective October 1, 2015, hospital inpatient cases using a drug-coated balloon (DCB)

More information

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K x ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the year ended December 31,

More information

Review of Intracoronary Radiation for In-Stent Restenosis

Review of Intracoronary Radiation for In-Stent Restenosis Review of Intracoronary Radiation for In-Stent Restenosis Robert Lew, MBBS, FRACP, Andrew Ajani, MD, Ron Waksman, MD, FACC Vascular Brachytherapy using beta and gamma radiation is the standard care for

More information

Vascular Disease in Women. Aimee Swartz, MD RPVI Vascular and Endovascular Associates of WNY

Vascular Disease in Women. Aimee Swartz, MD RPVI Vascular and Endovascular Associates of WNY Vascular Disease in Women Aimee Swartz, MD RPVI Vascular and Endovascular Associates of WNY Vascular Disease Atherosclerosis Hardening of the arteries Restriction of blood flow Arteries beyond the heart

More information

California Health and Safety Code, Section 1256.01

California Health and Safety Code, Section 1256.01 California Health and Safety Code, Section 1256.01 1256.01. (a) The Elective Percutaneous Coronary Intervention (PCI) Pilot Program is hereby established in the department. The purpose of the pilot program

More information

Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b

Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013 Reference: NHS Commissioning Board Clinical Commissioning Policy Statement: Percutaneous

More information